MC-10-1227Inspection Number: INSP - 147905
Scheduled Inspection Date: August 19, 2010
Inspector: Perez, JanPierre
Owner: GRAFE, JENS
Job Address: 253 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: C&R AIR CONDITIONING CO
Building Department Comments
August 18, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)7624949
Phone Number
Permit Number: MC -7 -10 -1227
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Parcel Number 1132060134560
Phone: 305 -685 -6394
EXACT REPLACEMENT OF 3 1/2 TON SPLIT SYSTEM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 13 of 36
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: MECHANICAL
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. 1 h 1 01 2 Z
Owner's Name (Fee Simple Titleholder
Owner's Address p.
City l�/ t4 c �l State I -p. Zip � *'� 5 2 1 3 d
Phone #
Tenant/Lessee Name
Email
Job Address (where the work is being done) a 3 t E 99 -v
City Miami Shores Villa a County Miami -Dade Zip 3 0 lo s/
FOLIO / PARCEL #
Is Building Historically Designated YES NO / Flood Zone
Architect/Engineer's Name (i applicab
0 0
Value of Work For this Per
Type of Work: ['Addition ❑Alteration
Describe Work:
E -mail
Master Permit No.
Phone # Oos• ! LI • q oLi
Contractor's Company Name C. ±R A ∎ r C-0 h C1, Co, Phone # 30S tS 6 39 L'(
Contractor's Address Go - 7 3 N cA) 1t:4 C • c-f
City / Y) (R vM State f) • Zip 3 0 0 (.S
Qualifier Name K ®D Cr A ZC )^ r ys T Phone # 3O,1
State Certificate or Registration No. CA e ( h y 14 Certificate of Competency No. 0 Ltd'
Contact Phone
Phone #
3 en
Ai JUL 0 6 ?010 gy
BY: .!.
Square / Linear Foota f Work:
ENe Repair/Replace ❑ Demolition
3 1
i
Submittal Fee $ Permit Fee $ \ \ CCF $ (V.00 CO /CC $
Notary $ Training/Education Fee $ 1 • J
Scanning $ 3' Radon $ DPBR $
Double Fee $ Violation date:
Technology Fee $ 4•k()
Bond $
Structural Review. $ Total Fee Now Due $
See Reverse side -*
1 6
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Exp
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Signature
nt Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 6
day of sl"q [ , 20 10 , by , day of 1 , 20 10, by
who i ersonally kno to me or who has produced who i .ersonally kno n me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
vqy Z vi2
S"7"4.6 J Commissi DD 621880
Expires December 26, 2010
Bonded Thro Troy Fait Insurance e00- 3667019
Plans Examiner Zoning
Clerk checked